What ointment is recommended for treating hemorrhoids?

Recommended Ointments for Hemorrhoids

For temporary relief of hemorrhoidal symptoms, topical treatments containing hydrocortisone are recommended as first-line therapy, with mesalamine suppositories being the most effective option according to the American Gastroenterological Association. 1

First-Line Topical Treatments

• Hydrocortisone preparations:

  • Recommended for short-term management of hemorrhoids
  • Particularly effective for reducing inflammation and relieving symptoms like itching and discomfort
  • Safe and effective in pregnant women with no adverse events reported in studies 1

• Mesalamine (5-ASA) suppositories:

  • Most effective option according to the American Gastroenterological Association
  • Superior efficacy compared to placebo (RR 0.44,95% CI 0.34-0.56) 1
  • Particularly useful for internal hemorrhoids

• Delivery method considerations:

  • Patches with 4% or 5% strength are more effective than cream or ointment due to gradual delivery over hours 1
  • Suppositories may be more effective for internal hemorrhoids
  • Ointments and creams work better for external hemorrhoids or those at the anal verge

Treatment Algorithm Based on Hemorrhoid Grade

1. Grade I-II hemorrhoids:

   • Start with topical hydrocortisone preparations
   • Consider mesalamine suppositories for better efficacy
   • Combine with conservative measures (fiber, hydration, sitz baths)

2. Grade III-IV hemorrhoids:

   • Topical treatments as adjunctive therapy
   • Consider procedural interventions like rubber band ligation (resolves symptoms in 89% of patients) 1
   • Surgical approaches may be necessary if conservative and office-based treatments fail

Recent Evidence on Alternative Topical Treatments

Recent research (2024) suggests sucralfate-based topical products may be effective:

• Acts as a mechanical barrier to facilitate healing
• Showed significant improvement in patient-assessed symptoms
• High patient satisfaction and good tolerability 2
• However, this is newer evidence and not yet incorporated into major guidelines

Important Considerations and Precautions

• Duration of use: Limit hydrocortisone use to short-term management due to potential long-term safety concerns 1

• Special populations:

  • Pregnant women: Topical hydrocortisone preparations are safe and effective 1
  • Immunocompromised patients: Require careful evaluation due to higher infection risk 1
  • Patients with liver cirrhosis: Special caution needed to distinguish hemorrhoids from anal varices 1

• Avoid using intravenous lidocaine simultaneously with topical lidocaine-containing preparations to prevent toxicity 1

Complementary Approaches

Always combine topical treatments with conservative management:

• Increased fiber intake (25-30g daily)
• Adequate hydration
• Sitz baths 2-3 times daily
• Avoidance of straining during defecation
• Avoidance of prolonged sitting 1

These conservative measures are strongly recommended by both the American Society of Colon and Rectal Surgeons and the American Gastroenterological Association, and should be implemented alongside topical treatments for optimal outcomes.